Required Forms

Electronically sign and submit first 4 forms- Last form-Patient History Data Form print, complete and bring with you to first office visit.

(Patients are required to complete all 5 forms only one time)

(When submitting 4 forms, click submit button ONLY ONE time)

Forms Submitted by Email or Fax

1. HIPPA PRIVACY FORM

2. CONSENT FOR TREATMENT FORM

3. FEE SCHEDULE FORM

4. LATE CANCEL NO SHOW FORM

Forms Submitted Online

5. PATIENT HISTORY DATA FORM

6. FINANCIAL AGREEMENT

7. TELEMEDICINE PRESCRIBING FORM

Financial Agreement Form

CLICK HERE TO DOWNLOAD
FINANCIAL AGREEMENT FORM(#6)